There are three kinds of assisted living residences in Maine:
1. “Assisted living programs” provide personal care services to people living in residences that resemble apartment buildings. The apartments usually have a shared dining space.
2. “Residential care facilities” provide personal and health care services to people living in private and semi-private bedrooms. Residents usually share living and dining space.
3. “Private non-medical institutions” offer similar personal and health care services as above, but are funded through Medicaid. (See Financial Assistance below.)
Any of these may offer help with activities of daily living (ADLs) like eating and bathing, and instrumental activities of daily living (IADLs) like banking and housekeeping. They may also provide meals, care management, medication assistance, and nursing care.
Importantly for people whose loved ones have dementia, any of these residences may house people with Alzheimer’s disease or similar dementia in special wings or units, or in whole buildings offering dementia care. Among the requirements for these “Alzheimer’s / dementia care units” are weekly activities that incorporate improving gross motor skills (movement of arms and legs); self-care; and social, outdoor, spiritual, and sensory enhancement activities. The buildings’ design and construction must follow certain rules that benefit people with dementia, like circular hallways for residents prone to wander. Additional training for staff is also required (see below).
Assisted living in Maine is regulated by the state’s Department of Health and Human Services.
The average cost of assisted living with memory care per month in Maine is $6,780, which breaks down to about $222 per day and $81,360 annually. Maine assisted living homes are required by regulations to provide any potential resident with a statement that explains all services provided, with the costs of those services. File this document as protection against unexpected charges. Assisted living, without the additional services required for memory care, costs residents of Maine about $5,182 per month and $62,184 annually.
The state’s most expensive city for memory care is Portland, where the average cost is $8,655 per month and $103,860 annually. The cheapest place for memory care is outside Maine’s biggest cities—in rural areas, the average cost is $6,182 per month and $74,184 annually. Maine’s second-biggest city is Lewiston, where memory care costs about $7,060 per month and $84,720 annually.
New residents in assisted living in Maine must be medically evaluated within 30 days of moving in, and then at least annually. The evaluation must include assessing the need for ADL and IADL assistance, medication requirements, and whether nursing service is necessary. Every assisted living residence in Maine must have a standardized contract for new residents that lists each service provided and the related cost. Contracts must also include:
– Process for filing a grievance
– Tenancy obligations
– Admissions policy
– Resident rights
A packet must also be available to any potential residents that includes this information:
– Specifics on the type of assisted living program provided (see above)
– Licensure status
– Information and contacts for Maine’s Long Term Care Ombudsman
– Advocacy and state agency contact information
– Process for transfer and discharge
– Staff qualifications
Someone may be denied admittance or evicted because of:
– care needs that cannot be met at the residence,
– behavior that damages property or is dangerous to others,
– failure to pay.
The only requirements for room size are specific to Residential Care Facilities, where bedroom units for one person must be at least 100 square feet, or 160 square feet for two people. Two is the maximum number of people allowed in one unit in a Residential Care Facility. One toilet must be provided for every six people in a Residential Care Facility, and one bath or shower for every 15 people.
There are no required staffing ratios in Maine assisted living homes, except to say there must be adequate staff at all times to meet the needs of every resident’s service plan. At least one staffer must be on-duty and awake at all times. An on-site administrator, dietary coordinator, and pharmaceutical consultant must also be employed by Maine assisted living homes. Administrators must be licensed in assisted living or have at least five years of experience in a related field. Administrators must also complete state-approved training, with 12 hours annually of continuing education in a relevant field. Staff who work with residents with dementia must have had pre-service training provided by the residence, including 16 hours of orientation.
Through MaineCare (Medicaid in Maine is called MaineCare) state residents who qualify financially and medically, can enroll in the Affordable Assisted Living Facility Services program. See detailed MaineCare eligibility criteria or take a short eligibility test here. A rule of thumb for Medicaid eligibility in less than 2,000 in monthly income and less than $2,000 in countable assets. Readers should be aware that Medicaid, by law, cannot pay for room and board costs associated with memory care / assisted living. However, Medicaid can pay for care provided in those locations.
Veterans are statistically more likely to develop dementia. Relevant in all states including Maine is the VA’s Aid & Attendance pension program for veterans and surviving spouses, which is an amount of money added to veterans’ and survivors’ basic pensions. Applicants must be at least 65 years old (or disabled) and require assistance with activities of daily living (ADLs) like eating, bathing, and mobility. The cash assistance from these pensions can be used as the recipient wishes, meaning it can go toward the cost of memory care. In addition, the cost of residential care can be deducted from one’s income, effectively reducing the amount of calculable income used to determine the benefit amount. The latest (2020) maximum amount a veteran can receive through A&A is $27,194 per year, and surviving spouses can receive as much as $14,761. Learn more here.
There are also veterans homes in Maine, which are residential care facilities that provide long-term care for veterans. In addition to nursing home care, assisted living and memory care may be provided. Payment is made directly from the VA to the facility. State veterans homes are typically reserved for veterans whose need for care stems at least 70 percent from their military service. Because there is often a waiting list, contact a home before visiting to see if your loved one is eligible to live there.
Other ways to help pay for memory care include tax credits and deductions like the Credit for the Elderly and the Disabled, or the Child and Dependent Care Credit (if you can claim your elderly loved one as a dependent). Remember also that medical and dental expenses can be deducted, and that may include some assisted living costs.
A reverse mortgage may be a good option for a married person moving into memory care, if their spouse continues to live in the home. Should the spouse move from their home, the reverse mortgage would become due.
Elder care loans are for families to cover initial costs of moving into memory care, if you need a little help at first but can afford costs after the initial payments. For example, if one is waiting for a VA pension to be approved or waiting to sell a home.